Provider Demographics
NPI:1093008237
Name:GLENN, JORDAN J (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:J
Last Name:GLENN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-9058
Mailing Address - Country:US
Mailing Address - Phone:480-633-3388
Mailing Address - Fax:480-633-0255
Practice Address - Street 1:7727 W DEER VALLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2121
Practice Address - Country:US
Practice Address - Phone:602-843-8317
Practice Address - Fax:602-843-9091
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0068902086S0127X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery